Job Description

This is a Remote position

About Zealie

Zealie is a fast-growing Medical Billing Services company specializing in the Behavioral Healthcare industry. Our clients are substance use disorder treatment, addiction recovery, and mental health treatment centers that are saving lives on a daily basis. Our state of the art proprietary technology provides data analytics and revenue prediction tools to our clients to help them make strategic business decisions to grow their business. We are committed to delivering exceptional products and services to our clients and believe that our Utilization Review team plays a crucial role in achieving this mission. We are seeking motivated individuals with a desire to be a part of a winning team.

Job Summary

The Medical Records Appeal Team Lead is responsible for overseeing the daily operations of the Appeal team, ensuring that all SOP processes are executed efficiently and in compliance with regulatory standards. This role involves leading and managing a team of Medical Record Appeal Specialists, providing guidance, training, and support to ensure high-quality service delivery. The Medical Records Appeal Team Lead also plays a pivotal role in collaborating with clinical teams, insurance providers, and facility management to ensure that all documentation is aligned with insurance requirements and that all necessary documentation is complete, accurate and present before appeals are submitted to the payers. This position requires strong leadership, excellent communication skills, and a deep understanding of the complexities regarding medical records, appeal processes and required documentation for behavioral health services.

Responsibilities and Duties

Supervise, train, mentor, and provide ongoing support to the Appeal team, ensuring that all team members are performing their duties effectively and in accordance with company standards Conduct regular team meetings to discuss case management strategies, process improvements, and any challenges the team may face. Oversee the workload distribution among the team members, ensuring an equitable distribution of cases and timely completion of tasks Ensure that all Appeal and MR processes are followed consistently by the team, including documentation, implementing quality control measures to improve processes and resolve discrepancies, and maintaining compliance with HIPAA regulations. Monitor appeal team performance to ensure adherence to internal protocols and external regulatory requirements. Provide ongoing professional development opportunities for the team to enhance their skills and knowledge Ensure proper documentation practices are followed for all records and transactions. Maintain accurate and detailed records of team activities and performance. Perform additional duties as requested by direct Supervisor and/or Management Review Work of assigned specialists within the allotted time frame per SOP Pull charts for assigned claims, as needed Create Spreadsheets for Retrospective Review letters and follow Retrospective Review Letter Setup / Process guidelines As needed: draft written warnings/PIP's As needed: Enter Proofhub Tickets As needed: Assist updating the Audit Team SOP with changes needed

Qualifications and Skills

Excellent organizational, problem-solving, and decision-making skills Strong attention to detail and accuracy. Experience working with Payer portals Exceptional communication and interpersonal skills Proficiency in EHR systems and standard office software including Google Workspace, Google Drive, Google Sheets, Google Docs Ability to navigate various technology and software tools Ability to work independently and as part of a team Proven leadership and team management abilities. Ability to manage multiple tasks and priorities in a fast-paced environment

Education and Experience

High school diploma or equivalent required; Associate's degree in Health Information Management, Medical Records, or a related field preferred Previous experience in a medical records or health information role is advantageous. Experience with electronic health record (EHR) systems is highly desirable.

(Preferred):

Experience leading a team in a behavioral health setting, with a focus on utilization review and authorization processes. Knowledge of day-to-day operations in psychiatric or behavioral healthcare facilities, including all levels of care (Detox, RTC, PHP, IOP, OP, Aftercare). * A track record of implementing process improvements that enhance team efficiency and effectiveness.